基于功能影像学探讨百会治疗失眠的中枢机制

Discussion on The Central Mechanism of Baihui in The Treatment of Insomnia Based on Functional Imaging

百会为治疗失眠的效穴,临床使用频率高。功能影像学,广义上包括多种成像技术,狭义主要指功能性磁共振成像(fMRI),数据分析方法分为功能分离和功能整合两类,试验设计方案包括任务态(Tb-fMRI)与静息态(Rs-fMRI),静息态因操作简便且能直观反映针刺持续和累积效应而被广泛应用。多项fMRI研究表明,失眠患者在视觉区、感觉运动区、情绪相关脑区等存在局部功能异常,针刺百会单穴或组穴可引起特定脑区如顶叶、额叶、颞叶等的改变,从而改善睡眠。针刺单穴百会主要集中在Rs-fMRI局部一致性(ReHo)、比率低频振幅(fALFF)研究,而针刺百会组穴研究从Rs-fMRI局部一致性(ReHo)、度中心度(DC)、种子连接(FC),以及Tb-fMRI比率低频振幅(fALFF)等方面展开,研究发现不同研究方法和穴位组合下的脑区激活改变存在差异,且针刺百会组穴所调控脑区多于单穴针刺,体现了百会对失眠、认知和情绪的调节作用以及腧穴间的协同作用。然而,针刺百会引起的中枢信号改变复杂,功能影像作为评估失眠的中枢指标虽有潜力,但仍需更规范、深入的研究。

Baihui is a potent point for the treatment of insomnia and is used frequently in clinical practice.Functional imaging,broadly defined,includes a variety of imaging techniques,narrowly defined,mainly refers to functional magnetic resonance imaging(fMRI),data analysis methods are divided into two categories,functional separation and functional integration,and the experimental design scheme includes the task state(Tb-fMRI)and the resting state(Rs-fMRI),and the resting state has been widely used due to its ease of operation and ability to intuitively reflect the sustained and cumulative effects of acupuncture.Several fMRI studies have shown that insomnia patients have localized functional abnormalities in visual areas,sensory-motor areas,and emotion-related brain areas,etc.Acupuncture of a single point or a group of points at Baihui can cause changes in specific brain areas,such as parietal lobe,frontal lobe,temporal lobe,etc.,and thus improve sleep.Acupuncture of single acupoint Baihui mainly focuses on Rs-fMRI lo-cal consistency(ReHo)and ratiometric low-frequency amplitude(fALFF),while acupuncture of group acupoints of Baihui has been studied in terms of Rs-fMRI local consistency(ReHo),degree centrality(DC),seed connectivity(FC),as well as Tb-fMRI ratiomet-ric low-frequency amplitude(fALFF),and the study found that the local functional abnormalities in the brain areas under different research methods and combinations of acupoints can cause changes in specific brain areas such as parietal lobe and temporal lobe to improve sleep.It was found that there were differences in the activation changes of brain regions under different research methods and acupoint combinations,and that acupuncture of Baihui group acupoints regulated more brain regions than single acupoints,re-flecting the regulatory effects of Baihui on insomnia,cognition and emotion,as well as the synergistic effects among acupoints.However,the central signal changes induced by acupuncture at Baihui are complex,and although functional imaging has potential as a central indicator for assessing insomnia,more standardized and in-depth studies are needed.